A Notification from a Public Authority is submitted by, or on behalf of, a principal officer under s.45H(2) of the Corruption, Crime and Misconduct Act 2003 (CCM Act).

An Individual Report is submitted by a person wishing to report suspected misconduct (as a private individual) under s.45E(1).

Surname

First name

Address

Suburb

Postcode

Email

For minor misconduct reports by individuals, giving an email or postal address allows us to send you a receipt of submission and the opportunity for you to provide additional information.

For minor misconduct notifications by Principal Officers, the email address provided will be the primary means of communication regarding the matter being notified.

Home phone

Work phone

Mobile phone

Details of the suspected minor misconduct

Complaint *

Please describe the nature of the suspected misconduct – for example improper and unauthorised use of a government vehicle for a private commercial purpose.

Incident date

DD/MM/YYYY

Incident location

Agency

Officers involved

Please include any known contact information for public officers directly involved.

What happened

Please succinctly describe the details of the matter that leads you to suspect minor misconduct. For s.45H (2) notifications please include information about any actions planned or underway to deal with the matter.

Witnesses

Please include any known contact information for persons considered to be reliable witnesses about the suspected minor misconduct.

Have you previously complained to the PSC about this matter? *

Yes

No

Have you reported this matter to any other agency (including the CCC)? *